Short term results following hip arthroplasty (total/hemi) in elderly patients with femoral neck fracture in a tertiary care hospital

Abstract

Background: Intracapsular fractures of the neck of femur are a major cause of morbidity and mortality in elderly population in India. The primary goal of treatment in these patients is to get the patients to the preinjury level of functionality as early as possible and with minimal complications. Multiple modes of operative treatment in the form of fixation devices (screws, plates, nails) and replacement (hemi or total replacement) are available for this fracture. However, a high rate of complications and revision surgeries has been found after internal fixation in this population group owing to the unique challenges to fixation in the form of co morbidities and osteoporosis among others. Instead of internal fixation, replacement is thus a viable option. Materials and Methods: 100 patients (age >65 years) with a femoral neck fracture were treated over a two-year period (May 2018 to April 2020) with some form of hip replacement after appropriate anesthetic fitness. Results: We had good results in majority of the patients in terms of return to pre-fracture level of functionality, independent ambulation and satisfaction with the results. A majority of patients treated with hemiarthroplasty recovered without incidence while all patients of total hip replacement progressed without incidence. There were 10 cases of suture line infection which recovered satisfactorily with a change of antibiotics, 4 cases of deep infection for which debridement and implant removal was required, 3 cases of deep vein thrombosis and 7 cases of dislocation. Conclusion: Hip replacement is a viable option for treatment of femoral neck fractures in patients more than 65 years of age. Return to preinjury level of functionality is pretty satisfying and early if the patient is actively mobilized as early as possible postoperatively. There are no risks of nonunion, malunion and implant related complications as compared to internal fixation devices.